To Heal or To Patch?
Military Mental Health Workers in Iraqby Stephen Soldz
www.dissidentvoice.org
November 29, 2005

The
Wall Street Journal has a
new article on the role of mental health professionals in treating war
trauma in Iraq. The military has caught on to how these workers can aid
the war effort and has increased their per capita numbers. Rather than
seeking the best treatment to help traumatized soldiers recover from their
stressful and horrific experiences, these professionals attempt to patch
soldiers in order to return them to combat. As the article illustrates in
its lead paragraph:

Lt. Maria Kimble, an
Army mental-health worker, runs a two-person counseling team out of a
small plywood office here. As part of a "combat stress detachment," her
job is to help soldiers cope with the horror of the battlefield -- so that
they can return to it as soon as possible.

Ethical questions
are raised, and then ignored by these workers, who after all, are
primarily involved in serving the war effort:

"There are a lot of
ethical questions about it," says Col. Levandowski. "The oath I take as a
physician is to do no harm," he says. But "ultimately, we are in the
business of prosecuting a war."

Clearly, the best
interests of the patients are at best one of several factors weighed by
these professionals:

"I do ache for these
guys," says Col. Levandowski. "But if you send too many (soldiers) home,
the risk is that mental health will be seen as a ticket out of country."

Success is measured
as much by whether a soldier returns to combat as whether (s)he feels
better. Speaking of her treatment of a soldier affected by witnessing
bombings and bomb scenes, Lt. Kimble says that his condition is probably
staying level. "Anyone dealing with post-traumatic stress disorder should
have a calm, safe environment and not have to go back to such traumas,"
she says.

Sgt. Parkinson,
however, will likely finish his deployment, which ends in the spring. By
the standards of Iraq, Lt. Kimble says that is a success.

Since these mental
health professionals give greater priority to the needs of the military
for manpower than to the needs of the of the soldiers they treat, this
"treatment" raises serious ethical issues. Using common sense
interpretations, the treatment is in contradiction to the ethical codes of
most mental health professions. Thus, the
American
Psychological Association Code of Ethics says:

Psychologists strive
to benefit those with whom they work and take care to do no harm. In their
professional actions, psychologists seek to safeguard the welfare and
rights of those with whom they interact professionally and other affected
persons, and the welfare of animal subjects of research. When conflicts
occur among psychologists' obligations or concerns.

Surely, returning a
traumatized soldier to combat where he may be retraumatized does not
satisfy the "do no harm" provision. The American Psychological Association
does exempt those whose work requires them to perform in violation of its
ethics, if the psychologist takes steps to resolve the conflict between
orders and the Ethics Code. Do psychologists working in Iraq taken those
steps? I doubt it.

The American
Psychiatric Association has the
Principles of Medical Ethics With Annotations Especially Applicable to
Psychiatry. These Principles are clear that a physician "must
recognize responsibility to patients first and foremost." It further
states "a physician shall, while caring for a patient, regard
responsibility to the patient as paramount." In cases of conflict between
law and the best interests of the patient, "A physician shall respect the
law and also recognize a responsibility to seek changes in those
requirements which are contrary to the best interests of the patient." Do
military psychiatrists carry out their "responsibility to seek changes" in
policies that can return traumatized patients to combat? As the Wall
Street Journal article indicates, the answer is usually "no".

The
Code of Ethics of the National Association of Social Workers goes
further than the APAs in requiring social workers to notify clients of any
conflicts between their interests and the interests of other organizations
such as the military. The Code says that "Social workers' primary
responsibility is to promote the well-being of clients" However, the Code
does recognize potential conflicts between loyalty to clients and to "he
larger society or specific legal obligations." However, in cases of such
conflicts, "clients should be so advised." One wonders how often military
mental health workers advise soldiers that their primary loyalty is to the
larger military and not to the individual soldier they are "treating." Do
they let the soldiers know that their welfare matters only to the degree
it is consistent with returning the soldier to his/her unit? Unlikely.

Interestingly, while
the social workers' Code states that social workers "respect and promote
the right of clients to self-determination and assist clients in their
efforts to identify and clarify their goals," the Code goes on to state:

Social workers may
limit clients' right to self-determination when, in the social workers'
professional judgment, clients' actions or potential actions pose a
serious, foreseeable, and imminent risk to themselves or others.

One wonders how many
social workers in the military, like Lt. Kimble from the Wall Street
Journal article, have ever considered that returning a soldier to
combat may "pose a serious, foreseeable, and imminent risk to themselves
or others?" Surely, returning to a position where you stand a serious risk
of dying or being injured constitutes a risk to self. Additionally, having
a traumatized soldier on the streets of Iraq must often "pose a serious,
foreseeable, and imminent risk to others." Were any of those soldiers
lethally firing upon Iraqi civilians at roadblocks returned to combat
after being "treated" by one of "combat stress detachments?" Additionally,
other soldiers may be put at risk by having the comrade beside them
preoccupied by flashbacks or nightmares of previous horrors.

[In writing about
the social workers' Code, I do not mean to criticize the National
Association of Social Workers, which has taken a strong position against
he war from the beginning. See their October 7, 2002
Letter to President Bush, the NASW document A Legacy of Peace;
The Role of the Social Work Profession, and their
strong May 14, 2004 Letter to Senator Warner, Chair of the Senate
Armed Services Committee protesting abuse of POWs. Would that other
national mental health organizations, e.g., the American Psychological
Association or the American Psychiatric Association, had taken such strong
stands.]

These Ethics Codes
are only binding on members of the organizations promulgating them. If any
of the mental health professionals serving in Iraq are members of these
associations, they are technically subject. For example, if Lt. Maria
Kimble is a member of NASW, she would be subject to the NASW Code, on pain
of loosing her membership. However, these codes are considered to be
standards for ethical conduct for the profession in general.

I am not a strong
supporter of ethics codes, as they are frequently bureaucratic statements
designed to protect the profession from bad publicity or increased
regulation rather than to truly protect the public from wrongdoing.
However, having adopted these codes, one sign of their being taken
seriously by these professional organizations would be that action was
taken against egregious violations by those in service to the powerful,
such as those professionals serving in the military.

In additions to the
NASW positions mentioned above, these association have felt obligated to
take positions in the wake of the Abu Ghraib horrors and in response to
participation of psychologists and psychologists in the abuses at
Guantanamo, the American Psychiatric Association has announced that
psychiatrists should never participate in coercive interrogations, while
the
American Psychological Association bowed to the powerful and took a
weaker position, stating "psychologists do not direct, support, facilitate
or offer training in torture or cruel, inhumane or degrading treatment"
but, like the US government, this APA carefully avoided defining "torture
or cruel, inhumane or degrading treatment."

To my knowledge,
none of these major professional associations has directly addressed the
obvious ethical conflicts involved in mental health professionals aiding
the military by helping patch up soldiers only to send them back to suffer
potential further injury, mental and/or physical, in combat. While it
would be unlikely for these organizations to bite the hand that feeds them
and directly take on the military -- after all, the American Psychological
Association has had a division of military psychology since 1945 --
progressives can pressure these organizations to require member
professionals serving in the military to be up front with soldiers as to
their multiple and conflicted loyalties. Veterans and GI organizations can
alert soldiers to the dual loyalties of those offering to "help" them.
These organizations, and mental health professionals can help establish
alternative organizations, independent of the military, to help
traumatized soldiers when they get home. Beyond that, it remains for the
antiwar movements, and the citizenry at large, to fight against the wars
that create these ethical conflicts.